RT Journal Article SR Electronic T1 Lipid levels and major adverse cardiovascular events in patients initiated on statins for primary prevention: an international population-based cohort study protocol JF BJGP Open JO BJGP Open FD Royal College of General Practitioners SP bjgpopen20X101127 DO 10.3399/bjgpopen20X101127 A1 Joseph Edgar Blais A1 Ralph Kwame Akyea A1 Coetzee Annelize A1 Amy HY Chan A1 Wallis CY Lau A1 Kenneth KC Man A1 Jeff Harrison A1 Esther W Chan A1 Kebede A Beyene A1 Ian CK Wong A1 Stephen Weng YR 2020 UL http://bjgpopen.org/content/early/2020/11/05/bjgpopen20X101127.abstract AB Background: Clinical guidelines recommend specific targets for low-density lipoprotein cholesterol (LDL-C) and non–high-density lipoprotein cholesterol (non–HDL-C) for primary prevention of cardiovascular disease (CVD). Aim: To assess whether lower concentrations of LDL-C and non–HDL-C are associated with a reduced risk of major adverse cardiovascular events (MACE) in primary prevention of CVD. Individual variability in lipid response to statin therapy requires assessment this association in diverse populations. Design & setting International, new-user, cohort study, using data from three electronic health record databases from three regions: Clinical Practice Research Datalink, United Kingdom; PREDICT-CVD, New Zealand; and the Clinical Data and Analysis Reporting System, Hong Kong. Ethical approval has been obtained or waived as per local ethics policies. Method New statin users without a history of atherosclerotic CVD, heart failure, or chronic kidney disease, with baseline and follow-up lipid levels will be eligible for inclusion. Patients will be classified according to LDL-C (<1.4, 1.4 to 1.7, 1.8 to 2.5, ≥2.6 mmol/L) and non–HDL-C (<2.2, 2.2 to 2.5, 2.6 to 3.3, ≥3.4 mmol/L) concentrations twenty-four months after initiating statin therapy. The primary outcome of interest is MACE, defined as the first occurrence of coronary heart disease, stroke, or cardiovascular death. Secondary outcomes include all-cause mortality and the individual components of MACE. Sensitivity analyses will be conducted using lipid levels at three and twelve months after starting statin therapy. Conclusion Results will inform clinicians about the benefits of achieving guideline recommended concentrations of LDL-C for primary prevention of CVD.